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Bahall M. Cardiovascular Disease in the Caribbean: Risk Factor Trends, Care and Outcomes Still Far From Expectations. Cureus 2024; 16:e52581. [PMID: 38371068 PMCID: PMC10874633 DOI: 10.7759/cureus.52581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 02/20/2024] Open
Abstract
Cardiovascular diseases (CVD) are a major public health concern in the Caribbean. Cardiovascular care in the Caribbean revealed encouraging improvements but still less than expectations. This study aims to gain insight into CVD and identify gaps in cardiovascular care in the Caribbean compared to high-income countries. More specifically, this review reports on the epidemiology, CVD risk factors, management practices, and patient outcomes (quality of life (QOL) and mortality). A systematic review of peer-reviewed articles was conducted to assess the CVD of individuals in the Caribbean from 1959 to 2022.Using multiple search engines and keywords, a systematic review of relevant peer-reviewed CVD articles was conducted using the necessary inclusion and exclusion criteria. Relevant data of studies were classified by title, publication year, location, type and size of samples, and results. Further analysis grouped patients by epidemiological profile, CVD risk, management, and selected outcomes (quality of life and inpatient mortality). From the initial review of 1,553 articles, 36 were analyzed from Trinidad and Tobago (20), Barbados (4), Jamaica (7), along with the Bahamas (2), British Virgin Islands (1), Bonaire (1), and one article from a Caribbean study. The social environment of fast food, sedentary jobs, and stress determinants are postulated to be precursors for an increase in CV risks. CVD in the Caribbean reveals a high prevalence of CV risks, suboptimal care, poor compliance, and high inpatient mortality compared with high-income countries. Greater efforts are required to improve CVD care at all stages, including in the social environment.
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Affiliation(s)
- Mandreker Bahall
- Caribbean Centre for Health Systems Research and Development, Faculty of Medical Sciences, University of West Indies, St Augustine Campus, Couva, TTO
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Trihan JE, Lanéelle D, Metcalfe N, Perez Martin A, Frances P. Diabetes-associated dermatological manifestations in primary care and their association with vascular complications. J Diabetes Metab Disord 2020; 19:989-996. [PMID: 33520817 PMCID: PMC7843712 DOI: 10.1007/s40200-020-00594-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although type 2 diabetes mellitus (DM) is a global public health problem, the diabetes-associated dermatological (non-infectious) manifestations (DADM) remain poorly understood and under-diagnosed. We aimed to evaluate the prevalence of 7 known DADM in a primary care setting, and their association macro/microvascular complications. METHODS Cross-sectionnal study included patients consulting in general practice for DM-follow up, from November 2016 to January 2017. Patients aged <18 years old or consulting for other reason than DM follow up were excluded. Each patient were screened for diabetic dermopathy (DD), Huntley's papules (HP), necrobiosis lipoidica diabeticorum (NL), acanthosis nigricans (AN), cheiroarthropathy (CA, or stiff hand syndrom), scleredema adultorum of Buschke (SB) and bullosis diabeticorum (BD). RESULTS 213 diabetic patients were included over a period of 3 months. We found a prevalence of 17.8% (38 patients) for DD, 8.5% (18) for HP, 2.8% (6) for NL, 2.3% (5) for AN, 1.9% (4) for CA, 1.4% (3) for SB and 1.4% (3) for BD. DADM seems to be a risk factor for vascular complications (OR 1.97, p ≤ 0.001). Association with vascular involvement was stronger with DD and macroangiopathy (OR 1.86, p ≤ 0.001), and with NL and microangiopathy (OR 9.7, p ≤ 0.001). CONCLUSION In primary care, DM-associated dermatological manifestations present similar prevalence rates to a tertiary care setting, based on litterature. Complete dermatological examination of diabetic patients is essential and could lead to a better overall management of the pathology, as diabetic cutaneous manifestations appear as a sign of vascular involvement.
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Affiliation(s)
- Jean-Eudes Trihan
- Vascular Medicine Department, University Hospital, 86000 Poitiers, France
| | - Damien Lanéelle
- Vascular Medicine Department, University Hospital, 14000 Caen, France
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Guariguata L, Brown C, Sobers N, Hambleton I, Samuels TA, Unwin N. An updated systematic review and meta-analysis on the social determinants of diabetes and related risk factors in the Caribbean. Rev Panam Salud Publica 2018; 42:e171. [PMID: 31093199 PMCID: PMC6385809 DOI: 10.26633/rpsp.2018.171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/15/2018] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To conduct an analysis of the most recent data on diabetes and its risk factors by gender and other social determinants of health to understand why its prevalence is higher among women than men in the Caribbean; to inform policy agenda-setting for diabetes prevention and control in the Caribbean; and to identify gaps in the evidence that require further research. METHODS A previous systematic review of the literature describing studies conducted in the Caribbean that presented the distribution of diabetes, its outcomes, and risk factors, by one or more social determinants, was updated to include sources from 1 January 2007 - 31 December 2016. Surveys by the World Health Organization (WHO) were also included. Where data were sufficient, meta-analyses were undertaken. RESULTS A total of 8 326 manuscripts were identified. Of those, 282 were selected for full text review, and 114, for abstraction. In all, 36 papers, including WHO-related surveys, had sufficient information for meta-analysis. More women compared to men were obese (OR: 2.1; 95%CI = 1.65 - 2.69), physically inactive (OR: 2.18; 95%CI = 1.75 - 2.72), and had diabetes (OR: 1.48; 95%CI = 1.25 - 1.76). More men smoked (OR: 4.27; 95%CI = 3.18 - 5.74) and had inadequate fruit and vegetable intake (OR: 1.37; 95%CI = 1.21 - 1.57). CONCLUSION Thirty-six papers were added to the previously conducted systematic review; of those, 13 were added to the meta-analysis. Diabetes and its risk factors (primarily obesity and physical inactivity) continue to disproportionately affect women in the Caribbean. Smoking interventions should be targeted at men in this geographic area.
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Affiliation(s)
- Leonor Guariguata
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados.
| | - Catherine Brown
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados.
| | - Natasha Sobers
- Faculty of Medical Sciences, The University of the West Indies, Bridgetown, Barbados.
| | - Ian Hambleton
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados.
| | - T. Alafia Samuels
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, Barbados.
| | - Nigel Unwin
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
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Scribner RA, Radix RL, Gilliland AE, Leonardi C, Ferguson TF, Noel TP, Andall RG, Andall NR, Radix C, Frank R, Benjamin J, James J, Benjamin R, Waechter RL, Sothern MS. Absence of Adolescent Obesity in Grenada: Is This a Generational Effect? Front Public Health 2018; 6:204. [PMID: 30123791 PMCID: PMC6086203 DOI: 10.3389/fpubh.2018.00204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/03/2018] [Indexed: 01/15/2023] Open
Abstract
Background: Low- and middle-income countries are affected disproportionately by the ongoing global obesity pandemic. Representing a middle income country, the high prevalence of obesity among Grenadian adults as compared to US adults is expected as part of global obesity trends. The objective of this study was to determine if Grenadian adolescents have a higher prevalence of overweight compared to their US counterparts, and if a disparity exists between urban and rural adolescents. Methods: Using a subcohort of participants in the Grenadian Nutrition Student Survey, diet quality and anthropometric measures were collected from 55% of the classrooms of first year secondary students in Grenada (n = 639). Rural or urban designations were given to each school. Body Mass Index (BMI) was calculated and categorized as overweight or obese for each student following CDC classification cutoffs. A standardized BMI (BMIz) was calculated for each school. Sex-specific BMI and overall BMIz were compared to a 1980s US cohort. Multilevel models, overall and stratified by sex, of students nested within schools were conducted to determine if BMIz differed by rural or urban locality, gender, and diet quality. Results: The mean age of this cohort was 12.7 (SD = 0.8) years with 83.8% of the cohort identifying as Afro-Caribbean. Females had nearly twice the prevalence of overweight when compared to males (22.7 vs. 12.2%) but a similar prevalence of obesity (8.2 vs. 6.8%). Grenadian adolescents had lower prevalence of overweight (females: 22.7 vs. 44.7%; males: 12.2 vs. 38.8%, respectively) as compared to US counterparts. Eating a traditional diet was negatively associated with BMIz score among females ( β ^ = -0.395; SE = 0.123) in a stratified, multilevel analysis. BMIz scores did not differ significantly by rural or urban school designation. Conclusions: Among Grenadian adolescents, this study identified a lower overweight prevalence compared to US counterparts and no difference in overweight prevalence by urban or rural location. We hypothesize that the late introduction of processed foods to Grenada protected this cohort from obesogenic promoters due to a lack of fetal overnutrition. However, further research in subsequent birth cohorts is needed to determine if adolescent obesity will increase due to a generational effect.
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Affiliation(s)
- Richard A. Scribner
- Epidemiology Department, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, United States
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, United States
| | - Roger L. Radix
- Windward Islands Research and Education Foundation, St. George's University, St. George's, Grenada
| | - Aubrey E. Gilliland
- Epidemiology Department, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, United States
| | - Claudia Leonardi
- Behavioral and Community Health Sciences Department, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, United States
| | - Tekeda F. Ferguson
- Epidemiology Department, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, United States
| | - Trevor P. Noel
- Windward Islands Research and Education Foundation, St. George's University, St. George's, Grenada
| | - Rebecca G. Andall
- Windward Islands Research and Education Foundation, St. George's University, St. George's, Grenada
| | - Naomi R. Andall
- Windward Islands Research and Education Foundation, St. George's University, St. George's, Grenada
| | - Christal Radix
- Windward Islands Research and Education Foundation, St. George's University, St. George's, Grenada
| | - Rhoda Frank
- Windward Islands Research and Education Foundation, St. George's University, St. George's, Grenada
| | - Jonell Benjamin
- Windward Islands Research and Education Foundation, St. George's University, St. George's, Grenada
| | - Jenifer James
- Windward Islands Research and Education Foundation, St. George's University, St. George's, Grenada
| | - Romero Benjamin
- Windward Islands Research and Education Foundation, St. George's University, St. George's, Grenada
| | - Randall L. Waechter
- Windward Islands Research and Education Foundation, St. George's University, St. George's, Grenada
| | - Melinda S. Sothern
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, United States
- Behavioral and Community Health Sciences Department, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, United States
- Department of Pediatrics, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, United States
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Odunaiya NA, Grimmer K, Louw QA. High prevalence and clustering of modifiable CVD risk factors among rural adolescents in southwest Nigeria: implication for grass root prevention. BMC Public Health 2015; 15:661. [PMID: 26169588 PMCID: PMC4501296 DOI: 10.1186/s12889-015-2028-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 07/06/2015] [Indexed: 12/03/2022] Open
Abstract
Background Cardiovascular disease (CVD) is an immense global problem with serious economic and social consequences. Modifiable risk factors for CVD have been identified internationally in adolescents where early intervention programs have the potential to reduce CVD risk on individual and population levels. In developing countries such as Nigeria, little is known about the prevalence of modifiable CVD risk factors among adolescents especially in the rural areas. Methods This paper reports on a cross-sectional survey of modifiable CVD risk factors among rural adolescents in South-West Nigeria. All 15–18 years old adolescents in all the schools at Ibarapa central local government were approached and all those who assented and consented to participate in the study were involved. A total of 1500 adolescents participated in the study. Measurements of CVD risks factors taken were; smoking, physical activity, alcohol, dietary pattern using a questionnaire developed by authors. Other CVD risk factors such as waist hip ratio and BMI were taken using standardized instruments. Data were analyzed using STATA version 12. Results Data from 1079 adolescents (56.5 % males and 53.5 % females) were analyzed. Mean age of males was 16.4 ± 1.14 years and mean age for females was 16.29 ± 1.13 years. Adolescents showed clustering of CVD risk factors with about 72 % having between two and four risk factors. A total of 102 clustering patterns were reported. The most common clustering pattern (19.6 %) included high animal lipid and salt diet. Conclusion There is high level and clustering of CVD risk factors among rural adolescents in Southwest Nigeria. The most common clustering pattern was biased towards dietary factors. The high prevalence of CVD risk factors among rural adolescents in Southwest Nigeria suggests that urgent primary prevention programs are required to prevent the next generation of Nigerians from suffering of CVD. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2028-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N A Odunaiya
- Division of Physiotherapy, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa. .,Department of Physiotherapy, University of Ibadan, Ibadan, Nigeria.
| | - K Grimmer
- Division of Physiotherapy, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa. .,International Center for Allied Health Evidence, University of South Australia, Adelaide, Australia.
| | - Q A Louw
- Division of Physiotherapy, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
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Al-Rubeaan K. National surveillance for type 1, type 2 diabetes and prediabetes among children and adolescents: a population-based study (SAUDI-DM). J Epidemiol Community Health 2015; 69:1045-51. [PMID: 26085648 PMCID: PMC4680138 DOI: 10.1136/jech-2015-205710] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 06/02/2015] [Indexed: 01/08/2023]
Abstract
Background There is a paucity of data on the national prevalence of diabetes and prediabetes among youth. The Saudi Abnormal Glucose Metabolism and Diabetes Impact Study (SAUDI-DM) was used to assess the prevalence of type 1 and type 2 diabetes as well as impaired fasting glucose (IFG) among children and adolescents. Methods Sociodemographic, anthropometric and clinical data were collected through a nationwide household randomly selected 23 523 children and adolescents aged ≤18 years. Known participants with diabetes were classified according to their diabetes type, while participants without diabetes were subjected to fasting plasma glucose assessment and patients with diabetes were identified using the American Diabetes Association (ADA) criteria. All the studied participants were tested for lipid parameters. Multivariate logistic regression analysis was used to assess different risk factors. Results The overall prevalence of diabetes was 10.84%, of which 0.45% were known type 1 and type 2 patients with diabetes and 10.39% were either newly identified cases of diabetes (4.27%) or IFG (6.12%) with more than 90% of the participants with diabetes being unaware of their disease. The prevalence of known type 1 and type 2 diabetes as well as the newly identified cases was higher than what has been reported internationally. Age, male gender, obesity, urban residency, high family income and presence of dyslipidaemia were found to be significant risk factors for diabetes and IFG. Conclusions Diabetes and IFG are highly prevalent in this society with the majority of the patients being unaware of their disease, which warrants urgent adoption of early detection, treatment and prevention programmes.
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Sobers-Grannum N, Murphy MM, Nielsen A, Guell C, Samuels TA, Bishop L, Unwin N. Female gender is a social determinant of diabetes in the Caribbean: a systematic review and meta-analysis. PLoS One 2015; 10:e0126799. [PMID: 25996933 PMCID: PMC4440736 DOI: 10.1371/journal.pone.0126799] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 04/08/2015] [Indexed: 11/18/2022] Open
Abstract
Background Diabetes (DM) is estimated to affect 10–15% of the adult population in the Caribbean. Preventive efforts require population wide measures to address its social determinants. We undertook a systematic review to determine current knowledge about the social distribution of diabetes, its risk factors and major complications in the Caribbean. This paper describes our findings on the distribution by gender. Methods We searched Medline, Embase and five databases through the Virtual Health Library, for Caribbean studies published between 2007 and 2013 that described the distribution by gender for: known risk factors for Type 2 DM, prevalence of DM, and DM control or complications. PRISMA guidance on reporting systematic reviews on health equity was followed. Only quantitative studies (n>50) were included; each was assessed for risk of bias. Meta-analyses were performed, where appropriate, on studies with a low or medium risk of bias, using random effects models. Results We found 50 articles from 27 studies, yielding 118 relationships between gender and the outcomes. Women were more likely to have DM, obesity, be less physically active but less likely to smoke. In meta-analyses of good quality population-based studies odds ratios for women vs. men for DM, obesity and smoking were: 1.65 (95% CI 1.43, 1.91), 3.10 (2.43, 3.94), and 0.24 (0.17, 0.34). Three studies found men more likely to have better glycaemic control but only one achieved statistical significance. Conclusion and Implications Female gender is a determinant of DM prevalence in the Caribbean. In the vast majority of world regions women are at a similar or lower risk of type 2 diabetes than men, even when obesity is higher in women. Caribbean female excess of diabetes may be due to a much greater excess of risk factors in women, especially obesity. These findings have major implications for preventive policies and research.
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Affiliation(s)
| | - Madhuvanti M Murphy
- Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados
| | - Anders Nielsen
- Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados
| | - Cornelia Guell
- Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados; MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, United Kingdom
| | - T Alafia Samuels
- Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados
| | - Lisa Bishop
- Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados
| | - Nigel Unwin
- Faculty of Medical Sciences, University of the West Indies, Bridgetown, Barbados; MRC Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge, United Kingdom; Chronic Disease Research Centre, Tropical Medicine Research Institute, University of the West Indies, Bridgetown, Barbados
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Lima ACS, Araújo MFM, de Freitas RWJF, Zanetti ML, de Almeida PC, Damasceno MMC. Risk factors for type 2 diabetes mellitus in college students: association with sociodemographic variables. Rev Lat Am Enfermagem 2014; 22:484-90. [PMID: 25029061 PMCID: PMC4292619 DOI: 10.1590/0104-1169.3053.2441] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 04/09/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE identify the modifiable risk factors for type 2 diabetes mellitus in college students and associate these factors with their sociodemographic variables. METHOD cross-sectional study, involving 702 college students from Fortaleza-CE, Brazil. Sociodemographic, anthropometric, physical exercise data and blood pressure and fasting plasma glucose levels were collected. RESULTS the most prevalent risk factor was sedentariness, followed by overweight, central obesity, high fasting plasma glucose and arterial hypertension. A statistically significant association was found between overweight and sex (p=0.000), age (p=0.004) and marital status (p=0.012), as well as between central obesity and age (p=0.018) and marital status (p=0.007) and between high fasting plasma glucose and sex (p=0.033). CONCLUSION distinct risk factors were present in the study population, particularly sedentariness and overweight.
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Affiliation(s)
- Adman Câmara Soares Lima
- Doctoral student, Universidade Federal do Ceará, Fortaleza,
CE, Brazil. Professor, Faculdade de Ensino e Cultura do Ceará, Fortaleza, CE,
Brazil
| | - Márcio Flávio Moura Araújo
- PhD, Adjunct Professor, Universidade da Integração
Internacional da Lusofonia Afro-Brasileira, Acarape, CE, Brazil
| | | | - Maria Lúcia Zanetti
- PhD, Associate Professor, Escola de Enfermagem de Ribeirão
Preto, Universidade de São Paulo, WHO Collaborating Centre for Nursing
Research Development, Ribeirão Preto, SP, Brazil
| | - Paulo César de Almeida
- PhD, Collaborating Professor, Centro de Ciências da
Saúde, Universidade Estadual do Ceará, Fortaleza, CE, Brazil
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